Medical Billing Mesh

Medical Billing Mesh

Mesh placement medical billing can be a mess. Hernia repairs are very common, therefore mesh placements are very common. To keep your mesh placement medical billing accurate there are four steps to follow.

There are many different types of hernias. Mesh placement in medical billing is only allowed for two types: ventral and incisional hernia repairs. The first step to correctly do medical billing for mesh is to be sure the surgery was a ventral or incisional hernia repair.

The second medical billing step for mesh placement is similar to the first step. You must always remember that any other hernia repair will not reimburse separately for mesh placement. This means you may not separately bill for a 49468 if it is for an umbilical or epigastric hernia repair. Mesh placement is already included in the CPT code for the surgery.

The third medical billing tip is not to bill separately for the removal and repair of mesh. It may be tempting for a medical billing staff member to bill for the removal of infected mesh as well as a new mesh placement. However, this is incorrect. The CPT code for a mesh repair already includes reimbursement for the removal. However, there is one exception to this rule. If it is an unusual circumstance , the surgeon can bill with medical billing modifier 22 (Unusual procedural services). If there is enough supporting documentation as to why extra work was done, separate reimbursement may be given.

Sometimes mesh removal is the only procedure performed. This brings up tip number four. There is no medical billing code for mesh removal only. For example, if you’re patient complains of pain or has a skin erosion, you will use an unlisted procedure code. You will probably use the medical billing code 49999 (Unlisted procedure, abdomen, peritoneum and omentum).

There is nothing easy about mesh placement medical billing. However, if you stick to the four steps medical billing will be a snap.

View all Articles by: Melissa Clark, CCS-P